Aetna Medicare Prime (HMO-POS)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by Aetna Medicare
Additional Coverage
Hearing Vision Dental
Overall Government Star Rating
 4.0
out of 5 stars

State: Missouri

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C) with Prescription Drug (Part D)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D

 

$0
$0
$0
$0
$2,600 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

In-network: $0 copay
Out-of-network: 30% per visit
In-network: $30 per visit
Out-of-network: 30% per visit

Tests, labs, & imaging

In-network: $280 or 20%
Out-of-network: 30%
In-network: $0
Out-of-network: 30%
In-network: $30-70
Out-of-network: 30%
In-network: $0
Out-of-network: 30%
$120 per visit (always covered)
$30 per visit (always covered)

Hospital Services

In-network: $325 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: 30% per stay
In-network: $280 per visit
Out-of-network: 30% per visit

Skilled nursing facility

In-network: $20 per day for days 1 through 20
$178 per day for days 21 through 100
Out-of-network: 30% per stay

Preventive services

In-network: $0 copay
Out-of-network: 0-30%

Ambulance

In-network: $295
Out-of-network: $295

Therapy services

In-network: $40
Out-of-network: 30%
In-network: $40
Out-of-network: 30%

Mental health services

In-network: $40
Out-of-network: 30%
In-network: $40
Out-of-network: 30%
In-network: $40
Out-of-network: 30%
In-network: $40
Out-of-network: 30%

Opioid treatment services

Covered

Other services

In-network: 20% per item
Out-of-network: 30% per item
In-network: 20% per item
Out-of-network: 30% per item
In-network: 0-20% per item
Out-of-network: 0-20% per item

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$15.00 copay$15.00 copay


Generic drugs :
$3.60 copay or 5% (whichever costs more)

Brand-name drugs :
$8.95 copay or 5% (whichever costs more)

Generic$20.00 copay$20.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier33%
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

In-network: 20%
Out-of-network: 30%
In-network: 20%
Out-of-network: 30%

Extra Benefits

Hearing

In-network: $30
Out-of-network: 30%
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data

Preventive Dental

In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data

Comprehensive dental

In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data

Vision

In-network: $0 copay
Out-of-network: 30%
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data
In-network: $0 copay
Out-of-network: No Data

Other benefits

Limited coverage
Limited coverage
Not covered
Not covered
Limited coverage
Limited coverage
Not covered
 4
 3
 3
 4
 4
 5
 5
 5
 5
 4
 4

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